Metatarsal Head Resection: The Difference Between Recurrence and Reulceration- and how to avoid both?

A very thoughtful study from our SALSAmigos at the Universidad Complutense and Madrid and La Paloma Hospital in Gran Canaria. This study, evaluating patients following metatarsal head resection to treat diabetic foot ulcers with underlying osteomyelitis reported some interesting findings:

1. Recurrence: defined as a wound that occurred under the resected metatarsal head. This was associated, not surprisingly, from a proportionally smaller amount of bone resected. This tended to occur in the short term- median time ONE MONTH postoperatively.

2 Reulceration: defined as another wound appearing as a transfer-type lesion. Theoretically this is caused by excessive resection.

Abstract

Metatarsal head resection is a common and standardized treatment used as part of the surgical routine for metatarsal head osteomyelitis. The aim of this study was to define the influence of the amount of the metatarsal resection on the development of reulceration or ulcer recurrence in patients who suffered from plantar foot ulcer and underwent metatarsal surgery. We conducted a prospective study in 35 patients who underwent metatarsal head resection surgery to treat diabetic foot osteomyelitis with no prior history of foot surgeries, and these patients were included in a prospective follow-up over the course of at least 6 months in order to record reulceration or ulcer recurrences. Anteroposterior plain X-rays were taken before and after surgery. We also measured the portion of the metatarsal head that was removed and classified the patients according the resection rate of metatarsal (RRM) in first and second quartiles. We found statistical differences between the median RRM in patients who had an ulcer recurrence and patients without recurrences (21.48 ± 3.10% vs 28.12 ± 10.8%; P = .016). Seventeen (56.7%) patients were classified in the first quartile of RRM, which had an association with ulcer recurrence (P = .032; odds ratio = 1.41; 95% confidence interval = 1.04-1.92). RRM of less than 25% is associated with the development of a recurrence after surgery in the midterm follow-up, and therefore, planning before surgery is undertaken should be considered to avoid postsurgical complications.

Irene Sanz-Corbalán, DPM, PhD1, José Luis Lázaro-Martínez, DPM, PhD1, Javier Aragón-Sánchez, MD, PhD2, Esther García-Morales, DPM, PhD1, Raúl Molines-Barroso, DPM, PhD1, and Francisco Javier Alvaro-Afonso, DPM, PhD1

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